Pilbeam's Mechanical Ventilation: Physiological and Clinical Applications

Title page
Table of Contents
Copyright
Dedication
Contributors
Preface
Acknowledgments
Chapter 1. Basic Terms and Concepts of Mechanical Ventilation
	Physiological Terms and Concepts Related to Mechanical Ventilation
	Normal Mechanics of Spontaneous Ventilation
	Lung Characteristics
	Time Constants
	Types of Ventilators and Terms Used in Mechanical Ventilation
	Types of Mechanical Ventilation
	Definition of Pressures in Positive Pressure Ventilation
	Summary
Chapter 2. How Ventilators Work
	Historical Perspective on Ventilator Classification
	Internal Function
	Power Source or Input Power
	Control Systems and Circuits
	Power Transmission and Conversion System
	Summary
Chapter 3. How a Breath Is Delivered
	Basic Model of Ventilation in the Lung During Inspiration
	Factors Controlled and Measured During Inspiration
	Overview of Inspiratory Waveform Control
	Phases of a Breath and Phase Variables
	Types of Breaths
	Summary
Chapter 4. Establishing the Need for Mechanical Ventilation
	Acute Respiratory Failure
	Patient History and Diagnosis
	Physiological Measurements in Acute Respiratory Failure
	Overview of Criteria for Mechanical Ventilation
	Possible Alternatives to Invasive Ventilation
	Summary
Chapter 5. Selecting the Ventilator and the Mode
	Noninvasive and Invasive Positive Pressure Ventilation: Selecting The Patient Interface
	Full and Partial Ventilatory Support
	Breath Delivery and Modes of Ventilation
	Modes of Ventilation
	Bilevel Positive Airway Pressure
	Additional Modes of Ventilation
	Summary
Chapter 6. Initial Ventilator Settings
	Determining Initial Ventilator Settings During Volume-Controlled Ventilation
	Initial Settings During Volume-Controlled Ventilation
	Setting The Minute Ventilation: Special Considerations
	Inspiratory Pause During Volume Ventilation
	Determining Initial Ventilator Settings During Pressure Ventilation
	Setting Baseline Pressure: Physiological Positive End-Expiratory Pressure
	Summary
Chapter 7. Final Considerations in Ventilator Setup
	Selection of Additional Parameters and Final Ventilator Setup
	Sensitivity Setting
	Alarms
	Periodic Hyperinflation or Sighing
	Final Considerations In Ventilator Equipment Setup
	Selecting the Appropriate Ventilator
	Evaluation of Ventilator Performance
	Chronic Obstructive Pulmonary Disease
	Asthma
	Neuromuscular Disorders
	Closed Head Injury
	Acute Respiratory Distress Syndrome
	Acute Cardiogenic Pulmonary Edema and Congestive Heart Failure
	Summary
Chapter 8. Initial Patient Assessment
	Documentation of The Patient–Ventilator System
	The First 30 Minutes
	Monitoring Airway Pressures
	Vital Signs, Blood Pressure, and Physical Examination of The Chest
	Management of Endotracheal Tube and Tracheostomy Tube Cuffs
	Monitoring Compliance and Airway Resistance
	Comment Section of The Ventilator Flow Sheet
	Summary
Chapter 9. Ventilator Graphics
	Relationship of Flow, Pressure, Volume, and Time
	A Closer Look at Scalars, Curves, and Loops
	Using Graphics to Monitor Pulmonary Mechanics
	Assessing Patient–Ventilator Asynchrony
	Advanced Applications
	Summary
Chapter 10. Assessment of Respiratory Function
	Noninvasive Measurements of Blood Gases
	Capnography (Capnometry)
	Exhaled Nitric Oxide Monitoring
	Transcutaneous Monitoring
	Indirect Calorimetry and Metabolic Measurements
	Assessment of Respiratory System Mechanics
	Measurements
	Summary
Chapter 11. Hemodynamic Monitoring
	Review of Cardiovascular Principles
	Obtaining Hemodynamic Measurements
	Interpretation of Hemodynamic Profiles
	Clinical Applications
	Summary
Chapter 12. Methods to Improve Ventilation in Patient–Ventilator Management
	Correcting Ventilation Abnormalities
	Common Methods of Changing Ventilation Based on Paco2 and Ph
	Airway Clearance During Mechanical Ventilation
	Secretion Clearance From an Artificial Airway
	Administering Aerosols to Ventilated Patients
	Types of Aerosol-Generating Devices
	Postural Drainage and Chest Percussion
	Flexible Fiberoptic Bronchoscopy
	Additional Patient Management Techniques and Therapies in Ventilated Patients
	Fluid Balance
	Psychological and Sleep Status
	Patient Safety and Comfort
	Transport of Mechanically Ventilated Patients Within an Acute Care Facility
	Summary
Chapter 13. Improving Oxygenation and Management of Acute Respiratory Distress Syndrome
	Basics of Oxygenation Using FIO2, PEEP Studies, and Pressure–Volume Curves for Establishing Optimal PEEP
	Introduction to Positive End-Expiratory Pressure and Continuous Positive Airway Pressure
	Peep Ranges
	Indications for PEEP and CPAP
	Initiating PEEP Therapy
	Selecting The Appropriate PEEP/CPAP Level (Optimal PEEP)
	Use of Pulmonary Vascular Pressure Monitoring with PEEP
	Contraindications and Physiological Effects of PEEP
	Weaning from PEEP
	Acute Respiratory Distress Syndrome
	Pathophysiology
	Changes in Computed Tomogram with ARDS
	ARDS as an Inflammatory Process
	PEEP and the Vertical Gradient in ARDS
	Lung-Protective Strategies: Setting Tidal Volume and Pressures in ARDS
	Long-Term Follow-Up on ARDS
	Pressure–Volume Loops and Recruitment Maneuvers in Setting PEEP in ARDS
	Summary of Recruitment Maneuvers in ARDS
	The Importance of Body Position During Positive Pressure Ventilation
	Additional Patient Cases
	Summary
Chapter 14. Ventilator-Associated Pneumonia
	Epidemiology
	Pathogenesis of Ventilator-Associated Pneumonia
	Diagnosis of Ventilator-Associated Pneumonia
	Treatment of Ventilator-Associated Pneumonia
	Strategies to Prevent Ventilator-Associated Pneumonia
	Summary
Chapter 15. Sedatives, Analgesics, and Paralytics
	Sedatives and Analgesics
	Summary
Chapter 16. Extrapulmonary Effects of Mechanical Ventilation
	Effects of Positive Pressure Ventilation on the Heart and Thoracic Vessels
	Adverse Cardiovascular Effects of Positive Pressure Ventilation
	Factors Influencing Cardiovascular Effects of Positive Pressure Ventilation
	Beneficial Effects of Positive Pressure Ventilation on Heart Function in Patients With Left Ventricular Dysfunction
	Minimizing the Physiological Effects and Complications of Mechanical Ventilation
	Effects of Mechanical Ventilation on Intracranial Pressure, Renal Function, Liver Function, and Gastrointestinal Function
	Renal Effects of Mechanical Ventilation
	Effects of Mechanical Ventilation on Liver and Gastrointestinal Function
	Nutritional Complications During Mechanical Ventilation
	Summary
Chapter 17. Effects of Positive Pressure Ventilation on the Pulmonary System
	Lung Injury With Mechanical Ventilation
	Effects of Mechanical Ventilation on Gas Distribution and Pulmonary Blood Flow
	Respiratory and Metabolic Acid–Base Status in Mechanical Ventilation
	Air Trapping (Auto-PEEP)
	Hazards of Oxygen Therapy With Mechanical Ventilation
	Increased Work of Breathing
	Ventilator Mechanical and Operational Hazards
	Complications of the Artificial Airway
	Summary
Chapter 18. Troubleshooting and Problem Solving
	Definition of the Term Problem
	Protecting the Patient
	Identifying the Patient in Sudden Distress
	Patient-Related Problems
	Ventilator-Related Problems
	Common Alarm Situations
	Use of Graphics to Identify Ventilator Problems
	Unexpected Ventilator Responses
	Summary
Chapter 19. Basic Concepts of Noninvasive Positive Pressure Ventilation
	Types of Noninvasive Ventilation Techniques
	Goals of and Indications for Noninvasive Positive Pressure Ventilation
	Other Indications for Noninvasive Ventilation
	Patient Selection Criteria
	Equipment Selection for Noninvasive Ventilation
	Setup and Preparation for Noninvasive Ventilation
	Monitoring and Adjustment of Noninvasive Ventilation
	Aerosol Delivery in Noninvasive Ventilation
	Complications of Noninvasive Ventilation
	Discontinuing Noninvasive Ventilation
	Patient Care Team Concerns
	Summary
Chapter 20. Weaning and Discontinuation From Mechanical Ventilation
	Weaning Techniques
	Methods of Titrating Ventilator Support During Weaning
	Closed-Loop Control Modes for Ventilator Discontinuation
	Evidence-Based Weaning
	Evaluation of Clinical Criteria for Weaning
	Recommendation 1: Pathology of Ventilator Dependence
	Recommendation 2: Assessment of Readiness for Weaning Using Evaluation Criteria
	Recommendation 3: Assessment During a Spontaneous Breathing Trial
	Recommendation 4: Removal of the Artificial Airway
	Factors in Weaning Failure
	Nonrespiratory Factors that may Complicate Weaning
	Recommendation 6: Maintaining Ventilation in Patients with Spontaneous Breathing Trial Failure
	Final Recommendations
	Recommendation 8: Weaning Protocols
	Recommendation 9: Role of Tracheostomy in Weaning
	Recommendation 10: Long-Term Care Facilities for Patients Requiring Prolonged Ventilation
	Recommendation 11: Clinician Familiarity with Long-Term Care Facilities
	Recommendation 12: Weaning in Long-Term Ventilation Units
	Ethical Dilemma: Withholding and Withdrawing Ventilatory Support
	Summary
Chapter 21. Long-Term Ventilation
	Goals of Long-Term Mechanical Ventilation
	Sites for Ventilator-Dependent Patients
	Patient Selection
	Preparation for Discharge to The Home
	Follow-Up and Evaluation
	Equipment Selection for Home Ventilation
	Complications of Long-Term Positive Pressure Ventilation
	Alternatives to Invasive Mechanical Ventilation at Home
	Expiratory Muscle AIDS and Secretion Clearance
	Tracheostomy Tubes, Speaking Valves, and Tracheal Buttons
	Ancillary Equipment and Equipment Cleaning for Home Mechanical Ventilation
	Summary
Chapter 22. Neonatal and Pediatric Mechanical Ventilation
	Recognizing the Need for Mechanical Ventilatory Support
	Goals of Newborn and Pediatric Ventilatory Support
	Noninvasive Respiratory Support
	Conventional Mechanical Ventilation
	High-Frequency Ventilation
	Weaning and Extubation
	Adjunctive Forms of Respiratory Support
	Summary
Chapter 23. Special Techniques Used in Ventilatory Support
	Airway Pressure Release Ventilation
	Other Names
	Advantages of Airway Pressure Release Compared with Conventional Ventilation
	Disadvantages
	Initial Settings21,32,33
	Adjusting Ventilation and Oxygenation21,32,33
	Discontinuation
	High-Frequency Oscillatory Ventilation in the Adult
	Technical Aspects
	Initial Control Settings
	Indication and Exclusion Criteria
	Monitoring, Assessment, and Adjustment
	Adjusting Settings to Maintain Arterial Blood Gas Goals
	Returning to Conventional Ventilation
	Heliox Therapy and Mechanical Ventilation
	Gas Flow Through the Airways
	Heliox in Avoiding Intubation and During Mechanical Ventilation
	Postextubation Stridor
	Devices for Delivering Heliox in Spontaneously Breathing Patients
	Manufactured Heliox Delivery System
	Heliox and Aerosol Delivery During Mechanical Ventilation
	Monitoring the Electrical Activity of the Diaphragm and Neurally Adjusted Ventilatory Assist
	Review of Neural Control of Ventilation
	Diaphragm Electrical Activity Monitoring
	Neurally Adjusted Ventilatory Assist
	Summary
Appendix A. Answer Key
Appendix B Review of Abnormal Physiological Processes
Appendix C Graphics Exercises
Index
Abbreviations